Allergy Symptoms
Emergency Treatment Plans for Kids with Special or Chronic Health Issues
Be Better Prepared for Medical Emergencies
If your child has a chronic illness or special needs, there are several steps you can take to better prepare for medical emergencies, including development of an emergency treatment plan.
Introduction
If your child has a chronic illness or special needs, there are several steps that you can take to better prepare for medical emergencies. The most important is the preparation of an emergency treatment plan. Other steps include:- Registering information with your state 911 emergency communications center
- Arranging for your child's teachers to receive basic emergency training
- Preparing a "Go Bag" to take to the hospital
- Meeting with your local EMS service to share your plan with them
- Anticipating your child's needs in the event of a disaster
Emergency Treatment Plans
Develop an emergency treatment plan that will guide paramedics and emergency room staff when caring for your child in the event of a medical emergency.According to the American Academy of Pediatrics "When a crisis occurs and children with special health care needs must access the emergency system, they are often left vulnerable because of a lack of access to information about their medical problems. There can be delays in treatment, unnecessary tests, and sometimes serious errors as a result of lack of access to information available to the treating emergency physician." [1]
An emergency treatment plan does more than simply list your child's medical condition and current medications and allergies. It tells emergency medical providers how your child's special needs might affect or alter your child's care. The plan might specify, for example, higher doses of medications than would typically be administered by paramedics, or it might tell emergency room physicians not to apply a particular treatment that is dangerous for your child.
Developing a Plan
To develop a treatment plan:- Discuss preparation of the plan with your child's doctor or specialist
- Use the "emergency information form" provided by the American Academy of Pediatrics as a template
- Have your doctor sign the form to ensure that it will be followed
- Prehospital care may differ from emergency room care; make sure your plan covers both
- Contact your EMS agency to see if they have any recommendations
You should work with your child's doctor or specialist to develop the treatment plan. You may need to advocate for development of a plan, as some doctors are not familiar with them or understand why they are required. Although you can complete some of the information on your own, most of the information will be provided by your child's doctor, and the plan should be signed by the doctor to help ensure that it will be followed in an emergency.
The American Academy of Pediatrics website provides blank forms (they refer to emergency treatment plans as "emergency information forms"), as well as several useful sample plans.
If you or your child's doctor prefer another format, it is important to organize the information so it can be reviewed quickly. Also, it is a good idea to have the plan recorded on the doctor's stationary to make it clear that it has been endorsed by the doctor.Although you will only need one treatment plan, it is important to ensure that it addresses both prehospital care provided by paramedics in your home and emergency department care provided by emergency physicians. Treatment options available to paramedics are often narrower than those available in the hospital emergency department. If the available treatments differ from those recommended by your child's specialist, there are two options. The specialist can use the emergency treatment plan to modify the standard treatment options. For example, the plan might direct paramedics to use a higher dosage of a medication than would normally be administered. Or the specialist may specify alternative treatments or medications. For example, the plan might state "if dexamethasone is not available, methylprednisolone may be substituted."
Consider contacting your local emergency medical service (i.e., ambulance or EMS service) to see if they have recommendations. They will be more familiar than your child's doctor with how local paramedic treatment options might affect your child's care. Be aware that an emergency treatment plan that seeks to modify paramedic treatment options may require the approval of the local EMS Medical Director, or you may need to follow some other specified procedure.
For emergency room physicians, who will typically have greater flexibility than paramedics, the plan might help them select among treatment options or dosages. For example, your plan might specify that "Ativan has shown greater efficacy in terminating John Smith's seizures than diazepam."
Talk with your child's school nurse and teacher to obtain their input. The school nurse is responsible for ensuring that the school is prepared to address your child's specialized healthcare needs, [4] and may have suggestions for how the plan will be implemented in the school environment (E.g., "John Smith will carry his EpiPen with him while at school.)
Communicate the Plan
Copies of the plan should be kept where you can find it easily in an emergency (e.g., your purse), and should be provided to your child's school, local EMS agency and hospital emergency department.The plan is only useful if you can find it rapidly in the event of a medical emergency. Once you have a written treatment plan, place copies:
- on your refrigerator
- in your "go bag" (see further below)
- in your car
- in your purse/wallet.
Provide copies to:
- your child's school or child care center[2]
- the local EMS agency[7]
- the local hospital emergency department.[6]
Ask your child's school to keep a copy in the classroom, not just in the nurse's files, [7] and that it accompany your child on field trips.[6] If your child has an Individualized Education Plan (IEP), the IEP should incorporate or reference your child's treatment plan.[4]
Review the information with your local EMS agency. They may share it with their EMTs and paramedics or may provide training to their staff concerning your child's condition.[6] Unfortunately, not all EMS services understand the value of learning about your child's condition in advance of an emergency; you may need to work with them to help them understand the importance of sharing your child's emergency treatment plan. The EMS agency may place a copy in their ambulances, but in the event of an emergency be prepared to provide a copy to the EMTs or paramedics when they arrive, rather than depending on them to locate the plan.
Finally, give a copy to the local hospital emergency department to which your child would be transported in the event of an emergency.[6] (The emergency department's nurse manager is often the appropriate contact.) The emergency department will likely have a place to store it, but once again in the event of an emergency bring copies with you to the emergency room.
Review the plan annually with your child's doctor. As your child grows weight-based dosages will need to be modified, and other conditions may have changed.
Don't Rely Solely on Technological Solutions
If you decide to store your plan online, make sure you keep paper copies at hand as well.There are websites that allow you to store your child's plan online. While there are significant potential benefits to storing and accessing an emergency treatment plan in digital format, no standard format has yet emerged and most EMS agencies and emergency departments would not be familiar with how to access your plan in an emergency. If you do decide to use one of the website solutions, make sure that you also keep paper copies readily available. Computer "flash drives" and other digital storage media suffer from similar shortcomings. Nonetheless, it is likely that electronic emergency treatment plans will become commonplace in the future, perhaps fostered by initiatives such as Google Health (www.google.com/health) that are seeking to bring standardization and widespread adoption of online medical records.
Register Information with 911
Make crucial information available to paramedics by providing your 911 emergency communications center with a brief description of your child's condition.In many states, you can provide a description of your child's condition to the state or local 911 emergency communications center and the information will be linked to your home telephone number. Thereafter, when you dial 911 from your home phone, the information you provided will appear on the dispatcher's screen and will be communicated to responding paramedics. This helps ensure that they are adequately prepared when they arrive.
Although this service is available in most areas, it is often not well advertised and it can be challenging to locate the appropriate contact information via the web. It's generally more effective to try to reach your 911 emergency communications center by telephone. Don't dial 911! Instead, most states have a general state government information number (some states, for example, use 311 or 211) that you can call to reach other state services. Or you can try to call directory assistance and ask for the business line for the state or local 911 emergency communications center.The type of information collected by 911 varies state by state, but in most areas the information recorded is less comprehensive than your child's emergency treatment plan. Finally, note that if you call from your cell phone, the information you provided would not be available.
Arrange Emergency Training for Your Child's Teachers
Your child's teachers should receive emergency training to ensure that they:- Know what to do until paramedics arrive
- Can perform CPR, if required
- Are capable of administering rescue medications, such as the EpiPen
If your child experiences an emergency while at school (or child care), it is important that your child's teachers know when to call 911 and what to do in the few minutes until paramedics arrive.[3][7] Obviously, they should have ready access to a copy of the treatment plan. Talk with your school principal or nurse about arranging basic emergency training, including the administration of emergency medications, for your child's teachers and other applicable school staff. Surprisingly, teachers in many areas do not have even basic CPR or first aid training.[2] Even the school nurse may not be familiar with recent changes in how to deal with pediatric medical emergencies.[2][5] For example, the latest recommendations for children with seizures include the use of Diastat, a rescue medication similar to an EpiPen, designed to be used by parents and others without formal medical training.
It is important that teachers, and not just the school nurse, know how to administer emergency medications. According to the American Academy of Pediatrics Guidelines for the Administration of Medication in School, as "these [emergencies] occur at unpredictable times when a school nurse may not be available, trained designated school staff should be available."[3] (Note that not all school jurisdictions allow staff other than the school nurse to administer medications.[2]) The training could be provided by the school nurse, by your doctor's office[4] or by your local EMS agency. If your child has an IEP, it should specify that emergency training is required.
Prepare a "Go Bag"
Assemble a "go bag" with medications and spare clothes that you can grab quickly to take with you to the hospital.When a medical emergency strikes, there is not enough time to gather all the items you will need to take with you to the hospital. Prepare a "go bag" to take with you in the event of an emergency that contains the things that your child (and you) will need in the first few hours. Items to store in your go bag include:
- a small supply of your child's medications
- your child's emergency treatment plan
- a change of clothes for you and your child
- contact numbers for doctors, family and friends
- formula and diapers (for an infant)
- a small amount of cash (e.g. $20)
- a bottle of water
- a favorite toy
Meet with Your Local EMS Service
Meet with your local EMS agency to educate them about your child's condition and determine:- their capabilities (e.g. do they always have a paramedic available?)
- how long it will take them to get to your home or school
- whether they will transport your child to your preferred hospital
You should meet with your local EMS service, both to provide them with information about your child's condition and to understand their capabilities as EMS agencies vary greatly. Some EMS agencies staff their ambulances with EMTs (EMS providers trained in basic life support), while others staff all ambulances with a paramedic (the highest level of EMS provider), and still others use a tiered approach, dispatching a paramedic only to serious emergencies. Ask how long it typically takes the EMS agency to respond and the distance between the closest station and your home. Some agencies are volunteer, some use paid staff and some use a combination of both (again, while you might expect that an agency using paid staff would respond more quickly or have better training, volunteer services often deliver superlative services.) In most instances, your EMS agency will only transport your child to hospitals in the immediate vicinity. If your child will require care at a specialized hospital, usually he or she will first be transported to a local hospital for stabilization, and then transferred to the specialized hospital. Where there is more than one local hospital available, you will generally be able to choose the hospital to which your child is transported, but be aware that in serious emergencies, the paramedics will usually head directly to the closest hospital.Preparing for a Disaster
Prepare a plan that will ensure that your child continues to receive appropriate medical care following a disaster evacuation.In the event of a flood or other disaster, you may not have access to your home or your child's medications, doctors or medical information for an extended period of time. If your child has a chronic illness or special healthcare need, you may need to make additional preparations to ensure that your child will continue to receive appropriate healthcare. The following websites provide useful information on disaster preparedness:
Conclusion
As in so many areas, children with special healthcare needs or with chronic illnesses face greater risks when they experience medical emergencies. Detailed, up-to-date information is essential to the provision of effective emergency medical care. An emergency treatment plan, together with the other steps described above, will help ensure that your child receives the emergency care that he or she needs.|
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